Central Ohio Primary Care sticking with telehealth

By Laurie Allen

Tuesday

Apr 28, 2020 at 12:05 PM

Here's what going to the doctor could look like post-coronavirus.

Less than a month ago, Dr. Matthew Skomorowski had a waiting room full of patients. The second week of April, he said, “There’s not a single person in my lobby. We don’t want people to come into the office.”

In normal times, that would seem a strange way to run an internal medicine practice, but the coronavirus has forced sudden and sometimes extreme changes. “The entire model of how we provide care for patients flipped,” he says.

An internist, Skomorowski is one of 420 physicians in the Central Ohio Primary Care network, which has roughly 75 offices throughout the area. It is the largest physician-owned primary care group in the country.

Since Ohio Gov. Mike DeWine issued a stay-at-home order last month, 90 percent of COPC’s patient visits have been done via video. The group has logged 40,000 televisits with a 97 percent patient satisfaction rate, CEO Dr. William Wulf says. By contrast, “In February, we weren’t doing any.”

The rapid ramp-up was a response to pleas from DeWine and Ohio Department of Health Director Dr. Amy Acton for people to stay at home. Acton, concerned with overwhelming the health care system and buying time to lessen the virus’ community impact, urged nervous citizens to phone their doctors first before making any decisions.

Ironically, COPC had just kicked off a “Phone Us First” campaign when the pandemic struck. With the new sense of urgency, call volume skyrocketed. “I remember it well, walking into the phone room Monday morning, and everybody’s eyes were wide open, the phones were buzzing, and all the lights were blinking,” Skomorowski says.

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Physicians’ focus has been keeping patients out of hospitals, so that only those with the most urgent needs are directed there. “We are decreasing (hospital) utilization because this virus is so contagious.” Wulf says. “We are less likely to send a patient to the ER, and we’re keeping people home that we previously would have seen in the office.” A clear case for hospitalization is shortness of breath from doing something as simple as walking across a room. The virus can quickly devastate the respiratory system.

Telehealth fills a major need by allowing doctors to continue to see patients, and so far, patients have been enthusiastic. Tech-savvy seniors or those with family to help have embraced the new way of seeing the doctor, and for those without internet access or support, COPC sends care specialists to the home with iPads. “Drive-up” televisits happen in office parking lots.

Telehealth is part of efforts to provide the most care in the safest way. COPC set up a drive-up coronavirus testing site in Westerville and opened a dedicated, PPE-stocked respiratory clinic in north Columbus. Most patients start with televisits, then on to the testing site and respiratory clinic if circumstances warrant, Skomorowki says.

Patients now find more after-hours support with a team of nurses and nurse practitioners who triage calls, then send them to a group of doctors who are in an Uber-like queue. Physicians see patients by video within a minute after their names come up.

“This is something we had not planned on,” Wulf says, “but quite honestly, we as primary care physicians have made ourselves quite unavailable” after normal business hours. “A pandemic has forced us to take on a new level of responsibility that we’re glad to have.”

He believes televisits will remain an integral part of the new normal in health care. “We are working hard to figure out what this looks like in July and August, or a year from now,” Wulf says. “Going forward, a percentage of office visits could and should be delivered by video. Employers should absolutely demand this for their employees, and patients should demand it as well.” An office visit may consume three hours of work productivity, and telemedicine can significantly reduce both time and cost.

Telehealth also may encourage patients to see their doctors when they normally might put off seeking help if they aren’t sure. In the interim, “a small issue turns into a much larger issue,” Skomorowski says. “I think it’s actually going to improve care significantly.”

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COPC is planning how it will reopen offices gradually, most likely with chronically ill patients who need regular visits, Wulf says. All patient visits “are going to look a lot different. You’ll text when you arrive, and we’ll go out to your car, give you a mask and take your temperature. Then you’ll go straight to the exam room. How long will that be? I don’t know. As we bring people out of their homes, we’re going to see (coronavirus infection) spike back up again.”

The pandemic’s financial consequences have wounded medical practices. Wulf says revenue is down about 50 percent since mid-March, although the ramp-up in televisits has improved the picture. “I could not be prouder of our physicians, who were willing to cancel 90 percent of their office visits because that’s what Gov. DeWine and Dr. Acton asked us to do. They asked us to mitigate, and the truth is, it worked.

"I think in Ohio, we’ve all done what we were asked us to do. We’ll all pay a financial price, but we’ve given the community time.”